Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data

These specifications are for use for data with discharges that occur between July 1, 2022 and June 30, 2023. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2024.

This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location.

The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:

1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.

2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted.

Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.

NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available.

For each encounter please also submit the following Linking Variables:

CMS Certification Number,

Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),

Date of Birth,

Sex,

Inpatient Admission Date, and

Discharge Date.

This version of the specifications uses Quality Data Model (QDM) version 5.5. Please refer to the Electronic Clinical Quality Improvement (eCQI) Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2025.

This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location.

The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:

1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.

2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted.

Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.

NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available.

For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:

Core Clinical Data Element                                        UCUM Unit

Bicarbonate----------------------------------meq/L

                                                                                          mmol/L

Creatinine------------------------------------mg/dL

                                                                                          umol/L

Glucose--------------------------------------mg/dL

                                                                                          mmol/L

Heart rate------------------------------------{Beats}/min

Hematocrit -----------------------------------%

Oxygen saturation (by pulse oximetry)----------%{Oxygen}

Potassium------------------------------------meq/L

                                                                                          mmol/L

Respiratory rate------------------------------{Breaths}/min

Sodium--------------------------------------meq/L

                                                                                         mmol/L

Systolic blood pressure-----------------------mm[Hg]

Temperature---------------------------------Cel

                                                                                         [degF]

Weight---------------------------------------kg

                                                                                          [lb_av]

                                                                                          g

White blood cell count ------------------------{Cells}/uL

                                                                                          10*3/uL

                                                                                          10*9/L

                                                                                           /mm3

For each encounter please also submit the following Linking Variables:

CMS Certification Number,

Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),

Date of Birth,

Sex,

Inpatient Admission Date, and

Discharge Date.

The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.

These specifications are for use for data with discharges that occur between July 1, 2024 and June 30, 2025. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2026.

This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service and Medicare Advantage encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location.

The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:

1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.

2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted.

Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.

NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available.

For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:

Core Clinical Data Element UCUM Unit

Bicarbonate----------------------------------meq/L

                                                                                          mmol/L

Creatinine------------------------------------mg/dL

                                                                                          umol/L

Glucose--------------------------------------mg/dL

                                                                                          mmol/L

Heart rate------------------------------------{Beats}/min

Hematocrit -----------------------------------%

Oxygen saturation (by pulse oximetry)-----%{Oxygen}

Potassium------------------------------------meq/L

                                                                                          mmol/L

Respiratory rate------------------------------{Breaths}/min

Sodium---------------------------------------meq/L

                                                                                            mmol/L

Systolic blood pressure----------------------mm[Hg]

Temperature----------------------------------Cel

                                                                                            [degF]

Weight-----------------------------------------kg

                                                                                             [lb_av]

                                                                                             g

White blood cell count ----------------------{Cells}/uL

                                                                                     10*3/uL

                                                                                     10*9/L

                                                                                     /mm3

For each encounter please also submit the following Linking Variables:

• CMS Certification Number,
• Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),
• Date of Birth,
• Sex,
• Inpatient Admission Date, and
• Discharge Date.

The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027.

This logic guides the user to extract the FIRST resulted HWR-specific CCDEs for all Medicare FFS and MA hospitalizations for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient/same day surgery location.

The logic supports extraction of the FIRST set of HWR-specific CCDE in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:

1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.

2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for CCDE values related to a patient who is subsequently admitted.

For weight, the logic supports extraction of the FIRST resulted vital sign recorded during the hospitalization, which may be prior to, or during admission.

Value sets for the laboratory tests are represented using Logical Observation Identifiers Names Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the CCDEs.

NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation.

For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any units may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and the median value reported for that CCDE will be imputed.

CCDE UCUM Units

Bicarbonate-------------------------------------meq/L

mmol/L

Creatinine---------------------------------------mg/dL

Glucose------------------------------------------mg/dL

mmol/L

-

Heart rate---------------------------------------{Beats}/min

Hematocrit --------------------------------------%

Oxygen saturation (by pulse oximetry)- -%{Oxygen}

Potassium----------------------------------------meq/L

mmol/L

Respiratory rate---------------------------------{Breaths}/min

Sodium--------------------------------------------meq/L

mmol/L

Systolic blood pressure-----------------------mm[Hg]

Temperature-------------------------------------Cel

[degF]

Weight---------------------------------------------kg

[lb_av]

g

White blood cell count -----------------------{Cells}/uL

10*3/uL

10*9/L

For each hospitalization please also submit the following Linking Variables:

CMS Certification Number (CCN);

National Provider Identifier (NPI) for MA patients;

Medicare Beneficiary Identifier (MBI);

Inpatient Admission Date; and

Discharge Date.

The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.